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Review
. 2020 Jun;8(5):536-543.
doi: 10.1177/2050640620909675. Epub 2020 Feb 26.

Clinical management of type C hepatic encephalopathy

Lorenzo Ridola  1 , Oliviero Riggio  1 , Stefania Gioia  1 , Jessica Faccioli  1 , Silvia Nardelli  1
Affiliations
Review

Clinical management of type C hepatic encephalopathy

Lorenzo Ridola et al. United European Gastroenterol J. 2020 Jun.

Abstract

Type-C hepatic encephalopathy is a complex neurological syndrome, characteristic of patients with liver disease, causing a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity, minimal hepatic encephalopathy, to a deep form in which a complete alteration of consciousness can be observed: overt hepatic encephalopathy. Overt hepatic encephalopathy occurs in 30-40% of patients. According to the time course, hepatic encephalopathy is subdivided into episodic, recurrent and persistent. Diagnostic strategies range from simple clinical scales to more complex psychometric and neurophysiological tools. Therapeutic options may vary between episodic hepatic encephalopathy, in which it is important to define and treat the precipitating factor and hepatic encephalopathy and secondary prophylaxis, where the standard of care is non-absorbable disaccharides and rifaximin. Grey areas and future needs remain the therapeutic approach to minimal hepatic encephalopathy and issues in the design of therapeutic studies for hepatic encephalopathy.

Keywords: Hepatic encephalopathy; cirrhosis; minimal hepatic encephalopathy; non-absorbable disaccharides; rifaximin; spontaneous portal-systemic shunts; transjugular intrahepatic portosystemic shunt.

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Figures

Figure 1.
Figure 1.
Classification of hepatic encephalopathy (HE) according to worsening of cognitive function (a) and time course (b), aimed to simplify the clinical pattern and easily and uniformly diagnose the presence of minimal, covert and overt HE.
Figure 2.
Figure 2.
Computed tomography (CT) scan and three-dimensional (3D) reconstruction of a large splenorenal shunt, frequently found in patients with persistent/recurrent hepatic encephalopathy (HE).
Figure 3.
Figure 3.
Transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene (PTFE)-covered placement: (a) computed tomography (CT) scan imaging of the spleno-portal vein system, (b) PTFE-covered stents, (c) and (d) angiography imaging of the procedure.
See this image and copyright information in PMC

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